Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
Palliat Med. 2013 Dec;27(10):885-98. doi: 10.1177/0269216312467489. Epub 2013 Jan 15.
Improved and cost-effective palliative and end-of-life care is an international policy imperative. Developments are impeded by a weak and often inconsistent evidence base.
To examine the main methodological challenges and limitations to developing and evaluating palliative and end-of-life care services and requirements to further this field of research.
A meta-synthesis to systematically appraise the evidence from systematic reviews on the research methods used in studies evaluating the effectiveness of palliative care services for patients with advanced illness and/or carers meeting inclusion and quality criteria. We extracted data from the reviews on the methodological issues reported on the included studies into Excel spreadsheets and generated textual descriptions coded and analysed in NVivo.
Six electronic databases, reference chaining and expert advice.
In total, 27 systematic reviews were included on the effectiveness of palliative care services for patients with cancer (n = 6), advanced illness (n = 10) or mixed populations (n = 11) across care settings. Main methodological challenges were implementation as a continuum, active precise recruitment, addressing randomisation and economic evaluation beyond cost savings.
The complexity of delivering and evaluating palliative and end-of-life care services requires the accumulation of knowledge from multiple sources to understand the active components of an intervention to deliver patient benefit and examine the evaluation methods to detect change and reveal processes prior to a definitive trial. The implementation of evidence into practice should form a continuum throughout the evaluation stages to reveal understanding on the process of intervention delivery, the context and the intended outcome(s).
改进和具有成本效益的姑息治疗和临终关怀是一项国际政策要求。由于证据基础薄弱且常常不一致，这方面的发展受到了阻碍。
研究制定和评估姑息治疗和临终关怀服务的主要方法挑战和局限性，以及进一步发展这一研究领域的要求。
一项元综合分析，旨在系统评估符合纳入标准和质量标准的研究中评估晚期疾病患者姑息治疗服务效果的研究方法的系统评价的证据。我们从综述中提取关于纳入研究中报告的方法问题的数据，输入 Excel 电子表格，并在 NVivo 中对生成的文本描述进行编码和分析。
六个电子数据库、参考文献链和专家建议。
共纳入了 27 项关于姑息治疗服务对癌症患者（n=6）、晚期疾病患者（n=10）或混合人群（n=11）的有效性的系统评价，涵盖了各种护理环境。主要的方法学挑战包括作为一个连续体的实施、积极精确的招募、解决随机化问题以及超越成本节约的经济评估。
姑息治疗和临终关怀服务的提供和评估的复杂性要求从多个来源积累知识，以了解干预措施的积极组成部分，为患者带来益处，并研究评估方法，以在进行确定性试验之前发现变化并揭示过程。证据在实践中的实施应该在评估阶段形成一个连续体，以揭示干预措施提供过程、背景和预期结果的理解。
